<include file="public@header" />
</head>
<body>
	<div class="wrap">
		<ul class="nav nav-tabs">
			<li ><a href="{:url('applynumbers/index')}">申户列表列表</a></li>
			<li class="active"><a href="{:url('applynumbers/add')}">添加申户列表</a></li>
		</ul>
		<form method="post" class="form-horizontal js-ajax-form margin-top-20" action="{:url('applynumbers/addpost')}">
			<div class="form-group">
				<label for="input-apply_name" class="col-sm-2 control-label"><span class="form-required">*</span>公司名称</label>
				<div class="col-md-6 col-sm-10">
					<input type="text" class="form-control" id="input-apply_name" name="apply_name">
				</div>
			</div>
			<div class="form-group">
				<label for="input-apply_url" class="col-sm-2 control-label"><span class="form-required">*</span>申户域名</label>
				<div class="col-md-6 col-sm-10">
					<textarea name="apply_url" style="width:100%; height: 120px;"></textarea>
				</div>
			</div>
			<div class="form-group">
				<label for="input-apply_one_agent" class="col-sm-2 control-label"><span class="form-required">*</span>首次代理</label>
				<div class="col-md-6 col-sm-10">
					<foreach name="apply_agent_config" item="vo">
						<div style="width:100px; float: left; margin-left: 10px;"><input type="checkbox" name="apply_one_agent[]" value="{$key}" style="zoom:120%;">&nbsp;&nbsp;{$vo}</div>
					</foreach>
				</div>
			</div>
			<div class="form-group">
				<label for="input-apply_one_blong" class="col-sm-2 control-label"><span class="form-required">*</span>归属一代</label>
				<div class="col-md-6 col-sm-10">
					<foreach name="apply_agent_config" item="vo">
						<div style="width:100px; float: left; margin-left: 10px;"><input type="checkbox" name="apply_one_blong[]" value="{$key}" style="zoom:120%;">&nbsp;&nbsp;{$vo}</div>
					</foreach>
				</div>
			</div>
			<div class="form-group">
				<label for="input-apply_two_blong" class="col-sm-2 control-label"><span class="form-required">*</span>归属二代</label>
				<div class="col-md-6 col-sm-10">
					<foreach name="apply_agent_config" item="vo">
						<div style="width:100px; float: left; margin-left: 10px;"><input type="checkbox" name="apply_two_blong[]" value="{$key}" style="zoom:120%;">&nbsp;&nbsp;{$vo}</div>
					</foreach>
				</div>
			</div>
			<div class="form-group">
				<label for="input-apply_main_status" class="col-sm-2 control-label"><span class="form-required">*</span>主体状态</label>
				<div class="col-md-6 col-sm-10">
					<select class="form-control" name="apply_main_status[]">
							<foreach name="apply_main_status_config" item="vo">
							 	<option value="{$key}">{$vo}</option>
							 </foreach>
						</select>
				</div>
			</div>
			<div class="form-group">
				<label for="input-apply_get_number" class="col-sm-2 control-label"><span class="form-required">*</span>开户数</label>
				<div class="col-md-6 col-sm-10">
					<input type="text" class="form-control" id="input-apply_get_number" name="apply_get_number">
				</div>
			</div>
			<div class="form-group">
				<label for="input-apply_done_number" class="col-sm-2 control-label"><span class="form-required">*</span>下户数</label>
				<div class="col-md-6 col-sm-10">
					<input type="text" class="form-control" id="input-apply_done_number" name="apply_done_number">
				</div>
			</div>
			<div class="form-group">
				<label for="input-apply_get_date" class="col-sm-2 control-label"><span class="form-required">*</span>申户日期</label>
				<div class="col-md-6 col-sm-10">
					<input type="text" class="form-control" id="input-apply_get_date" name="apply_get_date" value="<?php echo date('Y-m-d')?>">
				</div>
			</div>
			<div class="form-group">
				<label for="input-apply_done_date" class="col-sm-2 control-label"><span class="form-required">*</span>下户日期</label>
				<div class="col-md-6 col-sm-10">
					<input type="text" class="form-control" id="input-apply_done_date" name="apply_done_date" value="<?php echo date('Y-m-d')?>">
				</div>
			</div>
			<div class="form-group">
				<label for="input-apply_group" class="col-sm-2 control-label"><span class="form-required">*</span>申户组</label>
				<div class="col-md-6 col-sm-10">
					<input type="text" class="form-control" id="input-apply_group" name="apply_group">
				</div>
			</div>
			<div class="form-group">
				<label for="input-apply_user" class="col-sm-2 control-label"><span class="form-required">*</span>负责人</label>
				<div class="col-md-6 col-sm-10">
					<input type="text" class="form-control" id="input-apply_user" name="apply_user">
				</div>
			</div>
			<div class="form-group">
				<label for="input-apply_image" class="col-sm-2 control-label"><span class="form-required">*</span>营业照片</label>
				<div class="col-md-6 col-sm-10">
					<input id="photo-1" type="hidden" name="apply_image_bak1" >
					<input id="photo-1-name" type="text" name="apply_image" title="图片名称" style="display: none;">
					<img id="photo-1-preview" style="width:50px; height:50px;" name="apply_image">
					<a href="javascript:uploadOneImage('图片上传','#photo-1');">上传</a>
				</div>
			</div>
			<div class="form-group">
                                <label for="input-isblack" class="col-sm-2 control-label"><span class="form-required">*</span>是否拉黑</label>
                                <div class="col-md-6 col-sm-10">
                                        <select class="form-control" name="isblack">
                                                <option value="1">正常</option>
                                                <option value="2">拉黑</option>
                                        </select>
                                </div>
                        </div>
			<div class="form-group">
				<label for="input-apply_remark" class="col-sm-2 control-label"><span class="form-required">*</span>备注</label>
				<div class="col-md-6 col-sm-10">
					<textarea name="apply_remark" style="width:100%; height: 120px;"></textarea>
				</div>
			</div>
			

			<div class="form-group">
				<div class="col-sm-offset-2 col-sm-10">
					<button type="submit" class="btn btn-primary js-ajax-submit">{:lang('ADD')}</button>
					<a class="btn btn-default" href="javascript:history.back(-1);">{:lang('BACK')}</a>
				</div>
			</div>
		</form>
	</div>
	<script src="__STATIC__/js/admin.js"></script>
</body>
</html>
